The Future and Evolution of Cognitive Behavioural Therapy

Cognitive behavioural therapy (CBT) was first developed in the 1960s but has roots that can be traced back to the early part of the 20th century when ideas around ‘behaviourism’ were initially being discussed seriously within the field of psychology. CBT evolved by fusing elements of behaviourism (how we act) and cognitive therapy (how we think).

The philosophical origins of CBT are thought to be able to be traced to ancient Greek and Roman stoicism. Some practitioners of CBT have also incorporated Eastern spiritual practices, such as mindfulness, into their methodology.

Despite its ancient origins and fairly recent inception as a legitimate psychotherapy, cognitive behavioural therapy is evolving and being increasingly accepted as an effective way to deal with both mental and physical health conditions.

A Brief Overview of CBT

Cognitive behavioural therapy (CBT) is a type of talking therapy (also called psychotherapy) that aims to change and reframe the way we think and approach our problems.

According to ONS data, of the 2.5 million people in the UK who are economically inactive due to long-term sickness, 1.35 million (53%) reported this was due to depression, bad nerves or anxiety (either as a primary or secondary factor). CBT has been proven to be an effective treatment for common mental health conditions such as anxiety and depression.

The key aim of CBT is to reframe the way we think and approach problems, often trying to break them down into smaller, more manageable parts:

• Situation
• Thoughts
• Emotions
• Physical feelings
• Actions

At the core of CBT teachings is the idea that the above five areas are interconnected and that they affect one another. This means that your thoughts affect your feelings (emotional and physical) as well as how you respond to them. When we feel bad, we can get caught in a cycle of negative thoughts and negative emotions.

Broadly, CBT therapists work with patients to:

• Help them make sense of overwhelming problems by breaking them down
• Collaborate to establish achievable goals
• Identify negative thinking patterns
• Develop new thinking and behaviour patterns
• Develop new skills and strategies for problem solving

The aim of CBT is to change how we view our problems and thus how we feel about them and react to them. Furthermore, CBT is thought to help patients to develop healthier and more robust coping strategies to deal with their thoughts and behaviours. It can be practised in both one-on-one sessions and in group settings.

Unlike some alternative types of therapy, CBT usually has a cohesive goal in mind. Once a patient has achieved their original objectives and feels empowered to continue to use their new coping mechanisms, sessions will usually end.

Technology Integration

Technology is being increasingly integrated into mental health services via:

• Online counselling resources
• Remote therapy sessions
• Use of wellbeing apps

Technology can increase the reach of mental health services and make talking therapies like CBT accessible to people who struggle to get out of the house or live in remote or rural communities. Online therapy can also be more affordable, making it a more viable option for people who are less affluent. With waiting lists at an all-time high, it is becoming increasingly necessary in the UK to find affordable alternatives to NHS therapy.

Cognitive behavioural therapy that is delivered online via an internet programme or app is sometimes referred to as digital CBT or computerised CBT. This includes computer administered CBT (self-help, without therapist contact) or computer assisted therapy (computer administered, but with guidance and contact from a licensed therapist).

Some patients report that they prefer to receive support online via a computer, tablet or smartphone rather than travelling to weekly sessions. It is likely that in the future, more therapists will adapt the way they work to reflect this cultural shift towards using digital services.

As CBT is goal oriented, patients can also make use of apps to organise themselves and track their progress. CBT practitioners will often set ‘homework’ for patients to complete between sessions. Advancements in technology now allow some patients to communicate their achievements quickly and effectively with their therapist via an app or an instant message. This type of open communication can help keep patients engaged, which is key to CBT programmes being successful.

Personalised Treatment

The goal of offering personalised treatment within modern psychotherapy is to optimise treatment options for users and improve outcomes.

Contemporary CBT treatments can be further tailored to an individual using a combination of:

• Clinical assessment
• Information analysis
• Rapport and trust building
• Judgements that are based on theoretical frameworks, education and training
• Making changes and tailoring efforts based on patient responses
• Using both human and AI tools to improve treatment decisions

Artificial intelligence (AI) has a key role to play in the future of personalised CBT treatment. This might include using AI-powered tools to analyse a patient’s responses to questions, quizzes or surveys and provide personalised feedback and recommendations based on their answers. This can help patients better understand their thoughts, feelings and behaviours.

AI and machine learning approaches to analysing data and making predictions can complement traditional clinical judgements made by a therapist. This can lead to a more tailored and personalised approach to psychotherapy that is more adaptive and relevant to the individual’s needs and goals. This approach is particularly useful in goal-oriented therapies like CBT that rely heavily on user engagement and commitment.

Mindfulness and CBT

Some studies have found that practising mindfulness can help with some mental health issues such as:

• Stress
• Anxiety
• Depression

Mindfulness is centred around the idea of being present in the moment and paying attention to our thoughts, feelings, bodies and the environment around us.

To practise mindfulness, people try to become aware of thoughts and feelings as they happen, moment by moment. The art of mindfulness may be accompanied by deep breathing techniques or meditation.

Mindfulness techniques are thought to help improve our mental health by increasing our acceptance and understanding of our thoughts, teaching us to feel calmer and more in control of ourselves. Being mindful can help reduce unhelpful and intrusive or disruptive thoughts and teach us to be more reflective and less reactive to problematic thoughts, feelings and situations.

These strategies are consistent with the basic principles of CBT such as:

• Increasing emotional awareness
• Regulation of thoughts
• Recognising thoughts, emotions and behaviours
• Goal setting
• Learning self-regulation
• Listening without judgement

Cultural Sensitivity

CBT therapists are increasingly encouraged to consider cultural differences and to proceed with sensitivity when addressing these differences. Although symptoms of poor mental health permeate all cultures and ethnicities and are found worldwide, our thoughts and judgements towards mental health problems may vary significantly between communities.

The core aim of CBT is to identify and modify:

• Negative thought patterns
• Negative beliefs
• Negative behaviours

However, cultural factors may influence an individual’s experiences of mental health, attitudes to introspection and willingness to engage with a third-party therapist that is outside of their immediate network.

Some CBT practitioners are undertaking additional training to address cultural nuances and adjust their techniques to suit diverse populations. This is especially important to ensure that mental health services are accessible to a wide demographic to improve outcomes for all.

There may also be generational differences to consider, with some older people being more resistant to discussing mental health and less open to the idea of reframing their thoughts.

CBT can be a powerful tool for positivity. As cognitive behavioural therapy continues to evolve, hopefully awareness about the potential power of talking therapies also increases. In turn, we may start to break down some of the cultural and inter-generational barriers that prevent people from accessing, or engaging with, mental health services.

CBT for Prevention

Cognitive behavioural therapy may have a role to play in preventative mental health. By harnessing the power of thought management, reframing negative thought patterns and empowering individuals through CBT techniques, we can learn to:

• Problem solve more effectively
• Regulate our emotions
• Establish positive behaviour and thought patterns
• Accept ourselves as agents of change
• Normalise thought/behaviour modification (relating to CBT)

At risk populations (such as adolescents in care) can be encouraged to participate in CBT programmes as a preventative measure even if they are not showing signs of any mental health issues. The efficacy of such programmes will rely, in part, on how accessible they are to target groups. Furthermore, it is important to promote help-seeking behaviour and try to increase engagement with therapy schemes.

Emerging Research Areas

In addition to common mental health issues such as anxiety or depression, CBT is increasingly being considered as a technique to treat additional mental health conditions. These include:

CBT is also being increasingly considered an effective tool to help manage symptoms of certain long-term, physical health conditions, such as chronic pain.

Several studies have found that administering CBT both alone and in conjunction with other medical interventions, helps patients deal with physical discomfort. For some people, CBT offers a viable alternative to other measures that mitigate pain.

A course of cognitive behavioural therapy may also help patients who regularly suffer from pain to:

• Bipolar disorder (BD)
• Eating disorders (such as anorexia, bulimia, avoidant/restrictive food intake disorder (ARFID)
• Phobias (CBT for phobias may include elements of exposure therapy or desensitisation)
• Post-traumatic stress disorder (PTSD)
• Panic disorders
• Sleep problems (such as insomnia)
• Obsessive compulsive disorder (OCD)
• Alcohol or substance misuse problems

CBT is also being increasingly considered an effective tool to help manage symptoms of certain long-term, physical health conditions, such as chronic pain.

Several studies have found that administering CBT both alone and in conjunction with other medical interventions, helps patients deal with physical discomfort. For some people, CBT offers a viable alternative to other measures that mitigate pain.

A course of cognitive behavioural therapy may also help patients who regularly suffer from pain to:

• Become less reliant on taking painkillers to manage symptoms
• Provide a sense of increased control over their lives
• Feel some level of acceptance towards their condition
• Reduce stress and anxiety

Teletherapy and Accessibility

Teletherapy, also known as online therapy or e-therapy, is the delivery of mental health services through electronic communication. This includes:

• Videoconferencing
• Phone calls
• Online messaging platforms

There are many advantages of using teletherapy for delivering CBT, such as:

• Increased accessibility: Teletherapy can reach individuals who may not have access to in-person therapy due to location, mobility or time constraints.
• Comfort and convenience: Patients can participate in therapy from the comfort of their own homes, reducing the stigma associated with seeking mental health services.
• Flexibility: Teletherapy can be scheduled at times that are convenient for the patient, including evenings or weekends.

However, there are some drawbacks to using this approach, including:

• Technical issues: Internet connection problems, poor video quality or audio delays can disrupt therapy sessions.
• Lack of non-verbal cues: Teletherapy can make it more difficult for therapists to pick up on non-verbal cues, such as body language and facial expressions. Having the barrier of a screen there may also make patients feel more comfortable holding things back or not being as honest as they would be in person.
• Establishing rapport: Building a therapeutic relationship between a therapist and their patient can be more challenging in a teletherapy setting.

Conclusion

CBT is increasingly being used as an effective, accessible and non-invasive way to deal with a range of mental health disorders and other issues. The integration of technology with CBT is going to make psychotherapy more widely available and accessible in the future.

The interface of both human and AI interventions may help to offer a more personalised approach to CBT that accounts for individual nuances such as personal experience, age and cultural background, providing a more personal and holistic approach to psychotherapy.

With more people out of work due to mental health than ever before in the UK, cognitive behavioural therapy has the potential to be used as an increasingly accessible and non-invasive way to improve overall wellbeing and help people return to the workplace.